Download Guidelines for determining hearing aid output hearing

Guidelines for determining
hearing aid output, hearing aid
features, and fitting parameters
for children
Jace Wolfe, PhD
The Hearts for Hearing Team
Audiologists
Additional Team Members
Jace Wolfe, Ph.D., CCC-A
Kris Hopper
Kerri Brumley Pati Burns
Krystal Hudgens, AuD
Sherry Edwards Susan LaFleur Megan Miller
Megan Marsh, AuD
Reyna Romero Kristi Murphy Christian Boone
Natalie Martella, AuD
Darlene Hale
Kelsey Kuehn Verneda Osborne
Sara Neumann, AuD
Jackie Keathly
Mila Duke, AuD
Johnna Wallace, AuD
Elizabeth Musgrave, B.S., AuD Intern
Speech-Language Pathologists
Joanna T. Smith, M.S., CCC-SLP, LSLS Cert. AVT
Tamara Elder, M.S. CCC-SLP, LSLS Cert. AVT
Darcy Stowe, M.S. CCC-SLP, LSLS Cert. AVT
Lindsay Hannah, M.S., CCC-SLP, LSLS Cert. AVT
Carly Graham, M.S., CCC-SLP, LSLS Cert. AVT
Casey Banks, M.S., CCC-SLP
Jenn Bryngelson, CCC-SLP
Jenna Reese, M.S., CFY-SLP
Tessa Hixon, M.S., CFY-SLP
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Road Map
• Ensuring appropriate output for infants and
children using hearing aids.
• Technologies for Children
–
–
–
–
Audibility is king!
Digital Noise Reduction
Directional Microphones
Technology for the Telephone
Frequency Lowering
• Do they “work” for children?
• Should we use them with our
youngest patients?
Fitting Hearing Aids for Children
• How do I know when I have gotten it right?
Fitting Hearing Aids for Children
Search “American Academy of Audiology Pediatric Amplification Guideline”
http://www.audiology.org/resources/documentlibrary/Documents/PediatricAmplificationGuidelines.pdf
Fitting Hearing Aids for Children
Fitting Hearing Aids for Children
Fitting Hearing Aids for Children
The clinician should use independent pediatric-focused and
pediatric-validated prescriptive targets, normative data, and
fitting methods that take into account the unique developmental
and auditory needs of children.
DSL v5.0 for Children
NAL-NL2
Want to learn more about DSL v5.0 and NAL-NL2?
DSL v5.0
NAL-NL2
Fitting Hearing Aids for Children
The clinician should use independent pediatric-focused and
pediatric-validated prescriptive targets, normative data, and
fitting methods that take into account the unique developmental
and auditory needs of children.
The response of the hearing aid should be measured for a variety
of input levels to estimate the audibility of speech and to ensure
that the maximum output does not exceed prescribed levels.
Fitting Hearing Aids for Children
The clinician should use independent pediatric-focused and
pediatric-validated prescriptive targets, normative data, and
fitting methods that take into account the unique developmental
and auditory needs of children.
The response of the hearing aid should be measured for a variety
of input levels to estimate the audibility of speech and to ensure
that the maximum output does not exceed prescribed levels.
1) In situ probe microphone measurement
2) Simulated probe microphone measurement
Real Ear Probe Microphone
Measurement (In Situ)
Gold Standard: Measure RECD and conduct in situ probe microphone measure
Loudspeaker
Display
Probe Microphone
Ensure Goals Are Met Through Real Ear
Measures
Ensure Audibility
Speech Signal at
Multiple Levels
- 55 dB SPL
- 65 dB SPL
- 75 dB SPL
Ensure Comfort
& Safety
High-Level Swept
Pure Tone
What do I do with wiggly babies?
Simulated Real Ear Probe Microphone Measures
(Coupler)
Coupler Measurements in Infant Fittings
Real-Ear-to-Coupler Difference
Coupler Response
Real-Ear-to-Coupler Difference
Real Ear Response
Coupler Response
Real-Ear-to-Coupler Difference
Measured RECD
Average RECD
Figure 10: An illustration of an real-ear-to-coupler difference
response (RECD) measured from an adult hearing aid wearer.
This RECD is higher than the average value (dotted line).
Simulated Real Ear Probe
Microphone Assessment
• Hearing Aid Features for Children
DIGITAL NOISE REDUCTION IN
CONTEMPORARY HEARING AIDS
Digital Noise Reduction
• Classifies the input as either
speech or noise
• Reduces gain when the input to
the aid is primarily noise
• Wide variety in implementation
of DNR across manufacturers
• Studies with adults
– no change in speech
recognition
– Improvement in noise
tolerance, listening ease,
comfort, and cognitive load
Stelmachowicz et al., (2010) Ear and Hearing
Overall, DNR use resulted in no change in speech recognition in noise
• 16 children with mild to
moderately severe HL
– 8: 5-7 years old
– 8: 8-10 years old
• Evaluated speech
recognition in noise with
and without DNR (-6 dB)
Stelmachowicz et al., (2010) Ear and Hearing
Overall, DNR use resulted in no change in speech recognition in noise
• 16Other
children
with
mild toauditory performance for school-aged
studies
examining
children havesevere
also shown
moderately
HL no degradation in speech recognition in
– 8: 5-7 years old noise with the use of DNR.
– 8: 8-10 years old
-- Auriemmo
• Evaluated
speechet al., (2009), J American Acad Audiology
--Pittman (2011a), J Speech Language Hearing Research
recognition
in noise with
and without DNR (-6 dB)
Pittman (2011) J Speech Language Hearing Research
DNR may improve novel word learning as well as tolerance of noise
• NH children outperformed
children with HL
• Older children
outperformed younger
children
• Older children performed
better with DNR
Does DNR “work” for children?”
• Yes!
• At the very least, when implemented
correctly, it seems to result in no degradation
in speech recognition.
• It may improve listening ease, comfort,
cognitive load, and novel word learning.
Should we use DNR with our youngest children?
• Maybe
• We must verify that gain will not be reduced
when audible speech is present.
Ensuring DNR does not sacrifice audibility
• Inspired by
– Stelmachowicz et al (2010)
– McCreery (2011) – AudiologyOnline.com
Directional Technology for Children
• Experts are divided as to whether directional technology should
be used with young children
• Many experts do not explicitly recommend directional
amplification for infants and young children
– Ontario Guideline for Pediatric Amplification
– American Academy of Audiology Pediatric Amplification Guideline (2013)
However, some expert do condone directional mics for infants
…infants and young children should routinely be fit with
advanced directional microphones.
• What about the evidence?
• There’s very little in the way of direct evidence supporting the
benefits of directional use with infants and young children!
Ricketts & Galster (2007) American J of Audiology
Directional amplification reduced performance when signal arrived from behind
• Evaluated speech
recognition in 26 children
with mild to moderate HL
• Simulated classroom
environment
• Directional vs.
Omnidirectional
• Signal from front and signal
from behind
Additional Considerations
• Cons
– Little to no evidence suggesting
infants can orient toward signal of
interest
– Children 11 to 78 months orient to
the signal of interest about 40% of
the time, and majority of the
speech young children are exposed
to arrives incidentally (Ching et al,
2009)
– Incidental listening responsible for
90% of what a child learns about
the world (Cole and Flexer, 2009)
– No evidence showing benefits and
lack of detriment with adaptive
directional use in young children
• Pros
– Directional aids can improve
speech recognition in noise
– Directional mics are not that
directional in real world
environments
– Children may learn to orient
toward sound of interest
(Ricketts & Galster, 2008)
– Automatic/adaptive
directional aids may limit
directional detriment
Do directional mics “work” for children?”
• Yes!
• Research conclusively shows that they can improve speech
recognition in noise when the signal arrives from the front
• However, they may degrade speech recognition for signals
arriving from behind (Ching et al., 2009; Ricketts & Galster, 2007)
• There is no evidence supporting their efficacy for infants and
young children
Should we use directional amplification with children?
• Possibly
• Unlikely to be appropriate for infants birth through 9-12
months
• Likely okay for school-aged children
– Can they report on experiences?
– Do they understand rationale behind directional use?
– Can they (or the aid) reliably switch programs?
• More research is needed to develop and determine whether
adaptive directional microphones limit access to speech for
pre-school aged children
What about the telephone?
DuoPhone
• DuoPhone uses wireless streaming to deliver telephone
signal from one ear to the other.
• It allows for binaural listening on the telephone.
• DuoPhone Telephone Study with Children
Subjects
• Tested word recognition on the telephone with and without
DuoPhone in quiet and in noise for children with hearing loss
– 14 children (6-14 years-old)
• Recorded CNC words
– 10 children (2-5 years-old)
• NU-CHIPs words via live voice (open-set)
Mean CNC word recognition scores for older children (6-14 years-old)
100
90
80
70
60
Monaural
50
DuoPhone
40
30
20
10
0
Quiet
Noise (50 dBA)
Mean NU-CHIP word recognition scores for younger children (2-5 years-old)
100
90
80
70
60
Monaural
50
DuoPhone
40
30
20
10
0
Quiet
Noise (55 dBA)
Hailey with Monaural Telephone Use
Hailey with the DuoPhone
• What about frequency-lowering technology?
UWO Plural Test
NLFC Off vs. NLFC On
NLFC improves speech recognition on
UWO Plural Test by 16% points.
Wolfe et al. (2010), J Am Acad of Audiol
* P < .001
• Yes, it works.
• More from Andrea Bohnert!
Thank you for your attention!!!
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